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S RETROFIT OR REPAIR <br /> 1. Site map enclosed YES [ ] NO [ ] <br /> 2. Spec sheets attached for equipment to be installed YES [ ] NO [ ] <br /> 3. Description of work to be completed: <br /> VA ILA wD NK E p c A-c.P, A L L 3 91 P1 AC C S U P ur P, <br /> T to FiQ t n. 0?4 c C o &(c rt e re. <br /> 4. Description of equipment to be used: <br /> r(.R e-& L k rte. 4,(z it vtn A-9 w a�/ S <br /> 5. All equipment is State certified or approved. YES [ ] NO [ ) <br /> 6. Decontamination Procedures: <br /> a. Will piping be decontaminated prior to removal? YES [ ] NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name Phone( ) <br /> Address City Zip <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Phone(_) <br /> 2 <br />